EPISODE TRANSCRIPT
Content may be slightly edited for clarity.
Angelica
Hello, world, and welcome to So Curious, presented by the Franklin Institute.
Bey
In this season, Human 2.0, we will be talking to scientists and non-scientists alike about technology and innovation surrounding the human experience.
Angelica
We’re your hosts. I’m Angelica Pasquini.
Bey
And I’m the Bul Bey. But you can just call me Bey.
Angelica
On today’s episode, we’re going to be talking about organs with Brian Shepherd, and co-founder of the health design lab, Robert Pukeley. Organs.
Bey
Yeah. And the design of them and the printing of them and all these weird things of transplanting.
Angelica
Yeah. So typically organs are something that you don’t think about until you have to. Right. I remember when I signed up to be an organ donor.
Bey
Right.
Angelica
And I have to be honest with you, I did it. But there’s something about it that doesn’t always sit right with me. I’m going to be honest. I’m just like… Well, I saw this one dumb video once. The lady was awake because she wasn’t totally dead yet. But that’s not something that…. I don’t know what ….Dark web? No, it wasn’t. It was like 2020 Dateline. Yeah. But you know what? That’s a rare example. Are you an organ donor?
Bey
I have it listed on my driver’s license. Yes. I ignorantly don’t necessarily know what all the responsibilities mean from that.
Angelica
You will be dead, right?
Bey
And I’m kind of hoping that that’s the case. I know it’s one of those things where people are in need.
Angelica
Yeah.
Bey
And I’m always of the person, I’m always of the mind, rather, that people’s needs need to be met.
Angelica
Yeah.
Bey
And I know organ donation is something that is not popular. People kind of shy away from it.
Angelica
Yeah. It’s not a classic combo, but I do think that it’s like you obviously don’t think about it until you need it.
Bey
Right.
Angelica
But recently I heard about people who have healthy organs who know about the shortage of organs in our country, and they literally will go to a hospital and be like, I know I don’t need this organ and I’m willing to donate it. Yes.
Bey
Wow.
Bey
I noticed the whole system and even that….That’s not even something I’m aware of the mechanisms of, “I’d like to take this out of me and give it to somebody.”
Angelica
Yes.
Bey
Where do you even start? Where does that even begin? And who’s behind it?
Angelica
Okay, let’s get an expert in here, shall we?
Bey
Yeah, I’ll introduce him. Our first guest is Brian Shepherd from United Network for Organ Sharing (UNOS). UNOS is the engine that powers the US organ donation and transplantation system and matches organs with recipients.
Angelica
Hi, Brian. Could you introduce yourself in your own words?
Brian Shepherd
My name is Brian Shepherd. I’m the CEO of the United Network for Organ Sharing, UNOS. And what UNOS does is match donated organs with patients who need transplants. We really are the engine that powers the organ donation and transplant system, and we bring together the entire donation and transplant community: doctors, patients, and other professionals, together, to make the rules to drive that system.
Bey
Awesome. And one of the most interesting things to me about UNOS is that it’s not a part of the government, and it’s a nonprofit. Can you illuminate to the listeners how that works.
Brian Shepherd
When organ transplant was created, it really grew up regionally, because there are limits on how far you can transport an organ once it’s been recovered before you have to use it. And so in the 80s, Congress looked at this regional system that had developed and said, we really need a single unified national system. And they passed an act called the National Organ Transplant Act, or NOTA. But at the time, they said, we want government oversight, we want a single system, and we want government to have a role in making sure that they follow the rules, that it’s fair and that it’s appropriate. But we really want the experts in the community to be making these kinds of decisions. And so we want a private nonprofit organization that can bring together doctors and patients and let them make the decisions that drive this process.
Angelica
And that’s how you guys came to be.
Brian Shepherd
We came from one of the previous regional organizations that had sort of grown up organically, and that organization happened to be in Virginia, and they reached out to some of the other organizations and kind of assembled this team to bid for the very first contract under this new law in the 80s. And the government bids that contract out every five years or so, but we’ve been able to consistently win it and keep doing the work.
Angelica
Wow. What was one of the first things you guys changed when you were given this opportunity?
Brian Shepherd
Organ transplant is always a race against time. Once an organ is recovered, you’ve got to get to the recipient, get that organ implanted, because the longer it sits on ice, the more it’s going to deteriorate and the less useful it’s going to be. So a constant theme of the history of organ transplant is being able to reach further and further, as technology improves or clinical treatments improve. We can look for the sickest patient over a further and further distance all the time. It used to be they would have to be in the same hospital, or the donor would have to be just down the street. But now we can move an organ for hundreds of miles if that’s where the sickest patient is that needs that organ.
Bey
You know, a lot of people think organ transplant is about replacing people’s organs, but to my knowledge, it’s about extending that lifespan of the organ. Can you explain that a little bit more?
Brian Shepherd
So there’s really three phases of organ failure, care and pre-transplant. Because there are not enough organs to go around. If you can treat organ damage without a transplant, that’s better. And save that transplant for people who, really, that’s their only vehicle. So things like dialysis for kidney failure, things like heart assist devices for hearts, those are important pre-transplant remedies that make it possible, maybe, for people to postpone transplant or even avoid transplant altogether. But then there are devices that can improve the span of time that an organ spends in between the donor and the recipient. So devices that pump fluid and oxygen through organs to make sure that they last longer and are in better condition when they arrive at the recipient for transplant. And then there are constant improvements in the third phase, [which] would be after transplant. Immunosuppression medicines, better matching. Your body wants to reject a foreign object. Your immune system is supposed to repel things that don’t come from your own body. For an organ transplant recipient, it’s a constant balance of medicines that keep your immune reaction in check, to keep your own body from trying to get rid of the organ that you now have to save your life.
Angelica
Totally. Are you familiar with the show Gray’s Anatomy?
Brian Shepherd
I’m not the most familiar person on my team with Gray’s Anatomy, but it certainly gets talked about a fair amount around.
Angelica
Yeah, so basically in our culture (because this is something that you don’t learn about until it happens to you), it seems like our culture has dramatized this, and it is dramatic, of course, but we try to make a grasp using narrative storytelling. So on Gray’s Anatomy, Meredith Gray would always have to contact UNOS in deciding who gets an organ. But it’s very dramatized and extremely drawn out. We’re just curious a little bit about what UNOS is and also what it isn’t. Like, what are the misconceptions?
Brian Shepherd
So, it is dramatic. Whether it’s as dramatic in the moment as it is on Gray’s Anatomy, it’s probably harder to say. So what happens when a potential donor dies in a hospital? The hospital will contact an organ procurement organization, an OPO. And the OPO has staff that comes out and evaluates the donor, decides whether or not they’re able to be a good organ donor. For example, someone who dies of cancer is not likely to donate an organ because we don’t want to transmit that cancer. But the OPO staffer then puts all that clinical information into a computer that we operate. That’s what UNOS does. So we take that information, and we’ve got a database full of all the candidates for transplant, all the patients in the United States who need an organ transplant. And when the OPO says, “here’s a donor,” our computer system is the same one that all the hospitals and OPOs are using. And it says, “okay, here’s where the heart goes, here’s where the right kidney goes, here’s where the left kidney goes, here’s where the liver goes.” And they use that system to match that donor with the patients who are waiting.
Brian Shepherd
So in the moment, it’s impossible to sort of choose between people, right? So we have committees that are made up of doctors and patients and other professionals that write rules that help sort the patients into priority. And primarily for hearts, livers and lungs, the rules are the closer you are to death, the higher priority you are. For kidneys, it’s more the longer you’ve been waiting, the higher priority you are. So because of dialysis, you can wait longer. And so that tends to be more like just getting in line and waiting your turn. Whereas hearts, livers and lungs, you could go quickly up the list by being so sick that you’re about to die in the immediate future. So we have sort of set that IT system up to implement all those rules in the moment. So in the moment, there’s no committee that says, let me think about this person, but let me think about that person over there and try to compare them. It’s based on their clinical condition. It’s based on all the information their doctor has put in there. And that computer generates a list of candidates in order based on either how long they’ve been waiting or how sick they are.
Bey
That’s fascinating. You mentioned IT. Are there moments where just human judgment and the IT clashes?
Brian Shepherd
When the OPO puts the donor’s information into the computer, it’s not necessarily everything there is to know about that donor. And so what our system provides is an offer to a transplant doctor on behalf of his candidate. And sometimes that doctor can say, “you know what, this organ is not for us, not today.” And then we’ll go to the next person on the list, and the next person on the list, the next person on the list. So the computer isn’t completely insisting that this organ goes to this patient, but the computer does put them in order of priority to receive and consider those offers. So there is a doctor making that human judgment, but only if their patient is up next on the list.
Angelica
Around how many times a day is this happening?
Brian Shepherd
We’re going to get probably for the first time this year, 40,000 organ transplants in the United States. That’ll be the first time ever we’ve hit that number and the highest number in any country, in any year, in the world, which means that we’re doing a few more than 100 every single day.
Bey
The advent of new technology, like growing skin from stem cells and cloning organ cells and all that stuff, how far are we from the reality of just growing organs in a lab and what does science still need to do, or not do, to make this a possibility?
Brian Shepherd
So we are close enough to that to sort of see it over the horizon. Not close enough that if you need an organ now that you can count on that to be your solution, but close enough that we can kind of see it coming. There’s a group in Wake Forest. But for right now, it really is about the generosity of organ donors. It’s about people being willing to sign up to give their organs when they die and to make that available to other people because that is the current source. And that’s the way that organ transplant happens right now.
Bey
What does the history of transplantation as a medical practice look like and what were some of the first organ transplants? Do you know that history of it?
Brian Shepherd
Kidney transplantation has taken place at very low levels since really the 50s. Some of the first ones were done in Boston and in Virginia. The very earliest ones were living donor transplants, and the first one was done from a twin to his brother. And that’s how they were confident that it would match. As time went on, we learned more about deceased donation. We learned more about… Liver donation was mostly developed in Pittsburgh. Heart donation was really, started to become more established, in the 80s. It’s astonishing to look at the age of this field and think this is really brand-new. This is not something that my grandparents would have had access to at all. This field is really still in the very early stages of learning how this is done and making this happen.
Angelica
So organ tracking service operates with the same fluency as an Uber service. [Laughs] Right? So can you speak a little bit more to this, and why the journey of organs from donor to recipient is handled with so much care?
Brian Shepherd
Again, it really is because it’s always a race against time, to make sure that organ is still as high quality as it can be, and to get it to the right place. So we operate a GPS tracking system for organs, and we only recently developed it. And in the pilot phase, one of the very first instances we had was a courier who picked up a package and didn’t really understand, kind of, what they were carrying. And our team was watching them on a screen and saw that they were going away from the airport and actually were able to call and say, “that’s a kidney, and it has to make this flight.” And the Courier turned around and drove to the airport and got there on time. That doesn’t happen a lot. It was a break to get something that dramatic right at the beginning. But even allowing hospitals to know exactly when the organ is going to get there helps them get the transplant process started for their patients. A lot of times, at least, the surgical prep, and sometimes even some of the steps of the surgery, have begun as the organ is arriving because they know exactly when it’s coming. And they can make that process work a lot smoother for the patient and get that transplant done quicker.
Angelica
Wow. Cool! Well, we learned so much. Thank you so much for your time.
Bey
Yeah! Thank you.
Angelica
Let’s get a reflection. Well, that was really interesting because it seems like this organization, the priority, is decided by a committee. And I thought that was really interesting because you’re essentially removing…. I like the way he said, “because it’s anonymous, we’re not giving these to celebrities first.” That was good to hear.
Bey
Yeah. I had no clue about that system. The IT behind it. And I appreciated the clarification of when IT might clash with the human judgment side of deciding what goes where and how it gets there. But I really appreciated the level of care in transporting organs.
Angelica
Yeah.
Bey
It’s something that you don’t think about when your body is working well, but when something goes wrong, you want to have an efficient system, and this seems efficient. Do you think this could be more efficient in the future?
Angelica
Oh, my God. Imagine being a person driving the “Organ Über.”
Bey
The “Organ Uber” is five minutes away.
Angelica
Yeah. I think I could actually really lock into that and drive like, NASCAR.
Bey
Right.
Angelica
And then hopefully not get pulled over, but I would be really, really…I’d take that seriously.
Bey
Well, I would hope that there’s, like, some lane, some passing lane that you could just go into. “I am transporting an organ. I need to get to this place!” Because the lifespan of an organ is something that we opened up, too. I had no clue it was so, like, time-sensitive.
Angelica
Yeah, of course. And then also there’s, what he was introducing to us a bit, was the synthetic organ concept.
Bey
Yeah. Do you want a plastic or some kind of rubbery?
Angelica
I’m down. Whatever. If I need it, I’m open.
Bey
Right! I think the idea of it is like, no, I don’t want anything that’s made out of rubber or plastic. But if you’re in need, and something shuts down, I want that. Just give it to me.
Angelica
Exactly. Okay. Let’s get an expert in here, shall we?
Angelica
Our next guest is Robert S. Pugliese. Prior to taking on a fulltime role in healthcare innovation, Robert spent ten years practicing and teaching in the specialty of emergency medicine. As a person with insulin-dependent diabetes, Robert takes a personal interest in ensuring that everyone has a voice in improving our health care system.
Angelica
Okay. Robert, thank you so much for coming on to the show. Can you tell us a little bit first about who you are and what you do?
Robert Pugliese
On paper, I am the director of Innovation Design at Thomas Jefferson University in Jefferson Health, and I’m the cofounder and managing director of a place called the Health Design Lab. It’s a think tank, it’s a creative lab. It’s a place where people can come together to think differently and try to solve problems in healthcare using concepts of design and creative arts, and kind of bridging those two worlds together.
Angelica
So it’s design-specific.
Robert Pugliese
Our mission is twofold. We want more people in healthcare to start thinking about design as an important aspect to what we do. Right. An important aspect from providing care, to building environments for care, to doing surgery. Everything that we experience in health care is designed.
Brian Shepherd
How has design existed in the past?
Robert Pugliese
It’s basically like, I need a hammer. So here’s a hammer, right? It’s not a question of, wait, why are you trying to smash things with something and what do you really need? Right.
Bey
Yeah.
Robert Pugliese
And we frequently don’t ask those questions, which is why so much of the healthcare system is designed so poorly.
Angelica
I know that you guys are taking steps to encourage innovation and inclusivity in your space and you want to change the way we look at the future of healthcare. But I think first it would be cool to just better understand for people who might not know how it happened.
Robert Pugliese
Yeah, I wish I could really explain that in a very clear and well thought out way.
Bey
Yeah.
Robert Pugliese
But honestly, healthcare is a combination of systems layered upon systems, processes layered upon processes. Right? At some point, a long time ago, somebody did come up with a really great way of teaching medicine, practicing medicine. And then as things have changed, as the technologies have improved, as the way we do things have improved, people just start layering on systems, layering on systems. Add payment into the mix. Payment becomes really complicated. Add technology. It would be a discredit to the people who have done it well to say that it was all just bandaids and hacks, but it’s a lot of bandaids and hacks. Smashing two computer systems together and hoping that they’ll communicate. Or really well-meaning providers and health care professionals just doing what they can to serve their patients the best way they can with the tools at their disposal, which may not be the best.
Bey
As far as I understand, you’re using 3D printing technology to produce tissue similar to our natural body parts. Can you elaborate on that more? Could you explain more detail how this technology works?
Robert Pugliese
We’re trying to introduce people in health care to design. Well, on the other side of that, we’re also trying to bring designers and creatives into the world of healthcare. When you’re talking about technologies like 3D printing, this is not just something that a scientist can operate. You have experts. When we’re talking about bioprinting, you have experts in cell biology. How do you grow cells? How do you train cells to do certain things? How do you put cells together in ways that they begin to mimic an organ?
Bey
You can train a cell?
Robert Pugliese
You can. Yes, you can. That’s the basis of how a lot of basic science, biological science, is done, by taking these cell lines that have been, quote, unquote, trained to do very specific things, and using them as our experimental framework for how we test drugs and different chemicals and how they would react in a human but in a petri dish. That’s an entire field of expertise that doesn’t even begin to touch the 3D printing part. It’s a world of engineers and people who are technically experienced in things like software coding devices and non-biological materials. And bioprinting is the combination of those two things. People with these skill sets, they grow up, they learn in completely different environments. Usually they rarely talk to each other. And it’s only through very intentional kind of environments, or places like what we’re trying to create in the health design lab, where people can come together from disparate backgrounds and do something together to jump into the bioprinting space. It’s a growing field. It’s moving at an increasingly rapid pace. You’re going to see a lot of innovation in that space over the next 10, 20, and forever years.
Bey
Right.
Robert Pugliese
But we’re at early days, and there’s definitely experts around the world, not many who could really talk about the details of it. But I think what’s really cool to talk about is how did we get here? How did we get here to a place where suddenly we’re able to print life?
Angelica
Love that. How did we?
Bey
It’s mind blowing just to hear.
Robert Pugliese
Now imagine you’re struggling with your traditional on-paper printer that we’ve been working on and perfecting for decades now, and now increase the complexity of that by 10 to 100 fold. And that’s where we are with bioprinting.
Angelica
So bioprinting is part of the rapidly-growing field of regenerative medicine. Could you explain for our listeners what regenerative medicine is, and what the role bioprinting plays in the field?
Robert Pugliese
Regenerative medicine is what it sounds like, right? It’s the practice of trying to regain function or regain something that was lost. So if you’re talking about…Regain a function of an organ. So as a great example, I have type one diabetes. My pancreas no longer makes insulin. In order for my body to get insulin, I have to inject it into myself. In regenerative medicine, one of the biggest goals in science right now, and actually some great news about it last week, is that we want to figure out how to fix our pancreas so that it starts making insulin again. That’s regenerative medicine. And it can also span…. It’s not necessarily just like high-tech, reawakening broken organs. It’s also like, “I hurt myself and I need therapy in order to regain that function again.” Even that is a form of regenerative medicine, in a way.
Bey
And on your website, you describe how these 3D printing and scanning capabilities have the potential to decrease costs, improve outcomes, and improve patient experience. How important is the case of bioprinting in the field of regenerative medicine and human life as a whole?
Robert Pugliese
3D printing is already having a tremendous impact on all of our lives.
Angelica
Yes.
Robert Pugliese
And I do want to kind of segue from this concept of traditional printing to 3D printing to get us to bioprinting, because it is all the same chain. It is a progression through the same technology. This is all the same technology we’re talking about. The only thing that’s really changed is the ink.
Angelica
I like the ink analogy. What is the ink?
Robert Pugliese
We’re talking cells, we’re talking cells.
Angelica
Got it.
Robert Pugliese
So if traditional printers use ink, then 3D printers were invented and they use plastics. Through the magic of kind of trans-disciplinary collaboration, somebody was like, hey, we can take these 3D printers that squirt out hot plastic, and just put cells in there instead. And inject, in a very precise three-dimensional pattern, different combinations of living human cells. One of the most advanced utilizations of bioprinting right now is actually in two things: 3d printing functional human bladders, that is then implanted into a person.
Bey
That’s the capability that we have today as we speak.
Robert Pugliese
Yeah. So that is currently happening. That’s one of the only examples of a human organ that is being bioprinted for human implantation.
Bey
What does it mean for human beings, and what comes after that point?
Robert Pugliese
Other things that are being printed for implantation are like, stents. So kids who are born with an inability to keep their windpipe open, and they need a very specific-shaped thing to keep it open. Right now, certain centers are actually bioprinting. Sometimes it’s a plastic. Other times I’ve heard it being made out of collagen or different biological substances so that the body can absorb it, to keep that open. So that’s another really interesting kind of human use, and you start imagining the possibilities. Right. Researchers right now are printing these little miniature versions of organs to test substances that, before, we would have had to test on an animal or on a human. But they are able to replicate that kind of little system and put drugs in it and see how it responds, to accelerate the development of so many things. We’re not really constrained by the shapes and the complexity of structures and how we put them together. The wall that we have to get over is in the biological side.
Angelica
To make it fully functioning?
Robert Pugliese
To make it functioning, to make cell lines that do what we want them to do, to make them communicate, to replicate the complexity of the human body, is something we’re at very early days.
Bey
Rob, I want to ask about you. You’re a person who is open about being insulin-dependent and how this experience gives you a personal interest in making sure that everyone has a voice in improving our healthcare system. Could you speak more about your personal experience, how it informs your work, and how important it is to make sure that everyone has a voice in health care? How does the health design lab work to give everyone a voice?
Robert Pugliese
The crazy thing about working in health care, and kind of devoting your career to trying to make healthcare better, is that you realize that everybody has an experience with healthcare. Whether it’s good experiences, bad experiences… It’s hard to find somebody who hasn’t had a bad experience of some kind with our American health care system. I take that as kind of inspiration, to use myself as an example to get others to share and be open about their own personal experiences. Because health is a very personal thing. It’s not something that everybody wants to, nor should they have to, feel like they have to share. But hearing the experiences of others is the best way to try to improve. And one of the core tenets of what I do, and our work in the health design lab, is to encourage those voices to be heard.
Angelica
How essential is access to these types of technologies?
Robert Pugliese
So the technologies are becoming more and more accessible, and it’s one of those areas that is, again, accelerating almost as rapidly as computers and cell phones and video games. Pretty much anybody can buy a traditional 3D printer, build it themselves. And, yeah, think the cheapest one I’ve ever saw was like $60, maybe less now. So then what is the barrier now? What’s the barrier to you having a 3D printer, a bioprinter in your home, and making your own insulin? It’s the science part, right? It’s the getting to the point where you don’t have to be an expert to use the technology. Bioprinting. We’re still at the point where you have to be an expert to understand how to use the technology. In 10 or 20 years, that’s not going to be the case. I can’t even imagine what that would look like. But I could totally see that same trajectory where you can buy a printer, and you open up the instructions. It’s like, “pour bottle of pancreas into printer. Press go. Make sure the temperature is right before [so] you don’t burn it.” And then it just starts pumping out chemicals that you need to live.
Angelica
Do you have any examples of people who you’ve assisted in their research?
Robert Pugliese
That’s why we exist, right? That’s why the lab exists, is because we want to introduce these technologies to people who may not have taken that extra step to bring it into their work or bring it into their research because they thought it was too hard. They thought they didn’t have the skills. We started with one research project. We have four active research projects going on right now. And as the technology becomes more ubiquitous in the body of research and in different places, and people are seeing how impactful it can become, they’re looking for it. And instead of having to start from zero, they can just come to us and we can accelerate their discovery process.
Angelica
Awesome.
Bey
Amazing. Amazing. Amazing! Thank you for coming in and sharing all of your knowledge and experiences. This is like, really, really good stuff.
Angelica
Let’s get a reflection.
Angelica
That was a really fun interview.
Bey
Yeah. The overlapping of so many disciplines’ focus, because it’s not just printing and it’s not just biology. There’s so many different things, and no one knows it all at once. They have to communicate with each other.
Angelica
That was really cool. This whole introduction of the 3D printer is going to be… I think this is going to be like the next light bulb. Yeah, it’s going to be in the kitchen. It’s going to change everything. Yeah, it’ll be in the kitchen. It’ll be in every household. I think that what he’s saying is we’ll be able to 3D print everything and we’ll have to see what that’s going to end up looking like, and then the rules and regulations around it.
Bey
“I’m baking some cookies. I’m also printing a foot, wait a second.”
Angelica
[Laughter] Literally!
Angelica
Okay. This wraps up episode ten of So Curious! Thank you so much to Robert and Brian and thanks so much to you for tuning into this episode. This podcast is part of the Franklin Institute. The Franklin Institute is a science Museum located in Philadelphia. The Franklin Institute’s mission is to inspire a passion for learning about science and technology. For more information on everything about the Franklin Institute, visit fi.edu. This podcast is produced by Radio Kismet. Radio Kismet is Philadelphia’s premiere podcast network for businesses looking to develop their own branded podcast content. Check them out at radiokismet.com. There’s a lot of people who make this podcast happen. Thanks to the producers Joy Montefusco and Jayatri Das, our managing producer Emily Charish, our operations head, Christopher Plant, our associate producer, Liliana Green, our audio team Christian Cedarlund, Goldie Dangley, Lauren DeLuca and Brad Florent, our development producer Opeola Bukola, our science writer Kira Villette and our graphic designer, Emma Sager. See you next week.
